Preventing Attacks of Cluster Headache

Attacks are usually short, lasting from 15 - 180 minutes, and the excruciating pain may have subsided by the time a patient reaches a doctor's office or emergency room.Because it can be difficult to treat attacks when they occur, treatment efforts focus on the prevention of attacks during cluster cycles. Although certain drugs are standard, preventive therapy needs to be individually tailored for each patient. The doctor may prescribe a combination of drugs.

Verapamil (Calan), a calcium-channel blocker drug, is the mainstay preventive treatment for cluster headaches. However, it can take 2 to 3 weeks for this drug to take effect. During this period, corticosteroids (typically prednisone) may be used as an initial transitional therapy. For long-term treatment of chronic cluster headaches, lithium may be used as an alternative to verapamil.

Although they are not approved for cluster headache, anti-seizure drugs such as valproate (Depakote), topiramate (Topamax), and gabapentin (Neurontin), are sometimes used for preventive treatment.